Provider Demographics
NPI:1497235030
Name:SKOLNICK DENTAL ASSOCIATES SPEC LLC
Entity Type:Organization
Organization Name:SKOLNICK DENTAL ASSOCIATES SPEC LLC
Other - Org Name:CHILDSMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ETHAN
Authorized Official - Last Name:SKOLNICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-469-9100
Mailing Address - Street 1:65 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07201-2474
Mailing Address - Country:US
Mailing Address - Phone:908-469-9100
Mailing Address - Fax:
Practice Address - Street 1:65 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07201-2474
Practice Address - Country:US
Practice Address - Phone:908-469-9100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty